Treatments Of Pulp Chamber Bottom Perforation And Young Permanent Teeth With External Root Resorption

The pulp chamber floor wear is puncture between pulp and periodontal tissue resulted from improper endodontic treatment operation and pathological absorption.A large part of this is iatrogenic injury coming from improper endodontic treatment operated by physicians.If the treatment is inappropriate,the affected teeth might have to be removed and adverse effects might be brought to patient’s oral health and physiological function.Thus at the time of treatment,in addition to being familiar with the anatomy of master teeth,the physician needs to have a cautious attitude,standardized operation to avoid unnecessary damage to the patient.The treatment must also avoid accidental pulp bottom wear and if the perforation occurrs,accurate assessment of the affected teeth and following treatment of perforation is necessary.In a root canal therapy of immature permanent teeth,the large apical foramen can not seal the root tip area,which leads to the failure of treatment.It has been reported that the probability of external root absorption after trauma is 17.24%.Moreover,there may be still external root resorption even after a complete root canal therapy.MTA can produce good sealing effect,minimal leakage,best biocompatibility and normal hardening in wet environment.It is widely used in clinic,such as pulp chamber bottom wear,root canal lateral wear repair and root tip barrier.The strong basicity of MTA can also neutralize the acidic environment outside the root and produce an unfavorable environment for root absorbing cells.In this paper,application of MTA material in perforation of pulp bottom and apical barrier during operation are discussed,with emphasis on changes of external root resorption after root canal filling with MTA.The causes of each case,inlays,porcelain inlay,resin lamination repair,root canal treatment and other treatment related problems are discussed in this thesis too.Case 1 came from a patient with iatrogenic pulp bottom wear.MTA is applied in the pulp chamber floor repair in combination with conventional root canal therapy to save the affected teeth.MTA was also used to restore the patient’s appearance and masticatory function by full crown.Porcelain inlay,which could preserve the teeth tissue,was applied on the 36.The second case studied the root young permanent teeth,which was not completely closed.The patient experienced external root resorption after root injury occurred.Dental trauma resulted in dental pulp necrosis and periapical periodontitis.Apical development stopped and root resorption took place.The apical barrier with MTA significantly reduced root shadow and stop tooth root absorption.Whether or not further down flap root absorption area repair is needed depends on recovery situation of root absorption area.Case 3 is about chronic Chronic pulpitis arising from dental caries of 36 and 46.After conventional root canal therapy,resin slicing and filling repair were operated on 36 and 46,respectivelt.The fourth case was about acute pulpitis caused by caries at 44.Root canal therapy at another hospital could not ease the pain of patient.By shooting X-ray and microscope,the 44 root canal was found to be the 1-2 type of root canal which was near the middle and far direction.The symptoms disappeared after the treatment of the omission of the distal root canal,and the resin was filled with the root canal after treatment.